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13020125CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10391 PINEVILLE AVE CONTRACTT$SE PERMIT NO: 13020125 OWNER'S NAME: KUNTAL & MARGI SHAH L,LJ0Le � DATE ISSUED: 061I7f2013 OW R'S PHONE: 4086150101 r PHONE NO: JOB DESCRIPTION; RESIDENTIAL 11COMMERCIALE] lif LICENSED CONTRACTOR'S DECLARATION License Class-- _ Lic. # � 7 2-- ADD 2ND STORY ADDITION 1,139 SQ FT, REMODEL 1,500 — j� ContractorK_ '5y— C Date SQ FT THROUGH OUT (E), REMOVE AND REPLACE 200 AMP I hereby affirm that I am licensed under the provisions of Chapter 9 PANEL & WATER HEATER AND RE-ROOF GARAGE 4 SQ (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: 5450000 performance of the work for which this permit is issued. i have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36913015.00 Occupancy Type: permit is issued. _APPLICANT CERTiF[CATiON I certify that i have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 0 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY LAST CALLED INSPECTION. indemnify and keep harmless the City ofCupertina against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ice. > granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. L__,_2Dale.LLV&� RE-ROOFS: Si nature -. - All roofs shall be inspected prior to any roofing material being installed, If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Lawfor one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for safe (Sec,7044, Business & Professions Cade) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MA ERiALS DISCLOSURE construct the project (See.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Cade, Sections 25505, 25533, and 25534.A will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I stare or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Arca Air Quality Management District I performance of the work For which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9,32 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 05, 25533 and 25534. Section 3700 of the Labor Cade, for the performance of the work for which this _ Owner ora hor' ed tfgeriti z=�' ' �i� H -Dat permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCV become subject to the Worker's Compensation provisions of the Labor Cade, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply wilh such provisions or this permit shall be deemed revoked. work's for which this permit is issued (See. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes, (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which-may accrue against said City in consequence of the r understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. VIN CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10391 PINEVILLE AVE CONTRACTOR: KUNTAL & MARGI SHAH PERMIT NO: 13020125 OWNER'S NAME: KUNTAL & MARGI SHAH 10391 PINEVILLE AVE DATE ISSUED: 06/17/1013 OWNER'S PRONE: 4086150101 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ ADD 2ND STORY ADDITION 1,139 SQ FT, REMODEL 1,500 License Class Lie. 4 SQ FT THROUGH OUT (lir), REMOVE AND REPLACE 200 AMP Contractor Date PANEL & WATER HEATER AND RE -ROOF GARAGE 4 SQ 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $450000 performance of the work for which this permit is issued. l have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the wort: for which this APN Number. 36913015.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F T ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of Elie granting of this permit. Additionally, the applicant understands and will comply I ed by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed, If a roof is installed without First obtaining an inspection, 1 agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date; I hereby affirm that tam exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, +will do Elie work, and the structure is not intended or offered for sale (Sec,7044, Business & Professions Code) il, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which thisrr Owner or authorized agent: tt� r 3 Lam �_ Date: permit is issued. I certify that in the performance of the work for which this permit is issued, 1 shall of employ any person in any manner so as to become subject to the Worker's Compensation laws of California, If, after making this certificate ofexemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (See. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify [hat I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes, (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECTS DECLARATION costs, and expenses which may accrue against said City in consequence Df the I understand my plans shall be used as public records. granting of this permit. Additionally, (lie applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. r Signature KSCZL Date rk, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10391 PINEVILLE AVE CONTRACTOR: RELIABLE & LOYAL PERMIT NO: 13020125 CONSTRUCTION OWNER'S NAME: KUNTAL & MARGI SHAH 4036 TWYLA LN DATE ISSUED: 06/17/2013 OWNER'S PI{ONE: 4086150101 CAMPBELL, CA 95008 PHONE NO: (408) 866-6643 ❑ LICENSED CONTRACTOR'S DECLARATION 30B DESCRIPTION: RESIDENTIAL 0 COMMERCIAL 11 License Class Lie. N 2 ADD 2ND STORY ADDITION 1,139 SQ FT, REMODEL 1,500 t Contractor /?.r- L e�t �t Date 1 1 SQ FT THROUGH OUT (E), REMOVE AND REPLACE 200 AMP I hereby affirm that I am licensed under the provisions of Chapter 9 PANEL & WATER HEATER AND RE -ROOF GARAGE 4 SQ (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license Is in full force and effect. , k 91301 ERRED #1- TRUSS CALCS- ISSD 10/2811013 i1 I hereby affirm under penalty of perjury one of the full r e ions: 1 have 's Work:th and will maintain a certificate of consent to self -insure or y U t� Compensation, as provided for by Section 3700 of the Labor Codec e t Sq. Ft Floor Area: Valuation: $450000 performance of the work for which this permit is issued, DiM - I have and will maintain Worker's Compensation insurance, as provided for by Section 3700 of the labor Code, for the performance of the work for which this APN Number: 36913015.00 Occupancy Type: permit is issued. APPLICANT CERTIFrCATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY ROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the f granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ipnajiu'e._ -- to G RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of The following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not,intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's malcrial. Additionally, should I use equipmeut or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Muuicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 255 4. Own Date: d is issued. .r r.-ajLtlrizedsageiits = permit - I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION(D a 4 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION u`v 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 b(� (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or \� ADDITION ❑ ALTERATION I TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS f 0 -3"! t b `r v!E V j /APx I V j�M�. fJ+rT�i fl OWNERNAME PHONE t LOC6- j�, J S _0-IJO f E-MAIL I<�Un 1d STREET ADDRESS jV}�xq r , � I JV CITY. STATE, ZIP 1 irtrR1r7AjD 1 cA 15 0 t'tFAX /V CONTACT NAME [BVI �Nv �jP D / PHONE 61�6'�"! E -T5; SyS ©L -s16 STREETADDRFSS p` 1/ O &� L (J CITY /AST P N 'lay qLf Q/t FAX C2OW9M 13Gf 111 -SS3ILD l 4WNIZ AGENT ❑ CONTRhCTOR ❑ CONTRACTORAGENT ❑ AR(CVirrr`ECr ❑ ENNG'MER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _ � � may, U LICENSENUMBER T--CENSETYPF BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ( Tb �Yy! ^R & �CWG � M � ,� r 0 ` & ; I`c��1(/[j� n r /PM0 pT70 CPN( f�P�� 1`-7DI Y0 9, � _nh1Z(/-L4.3 EXISTING USE �S PROPOSEDUSE CONSTICTYPE y F 0 V-15 1 0STORIES �7 G' USE TYPE OCC. SQ.FT. VALUATION (S) /i�C/A �,G II_f`I1 � I (I /�f_ /7J y/�y °R° / V� NE`A'T"- 00Z �.pUL, e-3 i 0,ti, BATHROOM REMODELARFA� KITCHENl REMODELARFA L �O OTHER REMODELARFA �{C> •U PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGEAREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEINGADDED? O SECOND STORY ❑ YES ADDITION? ❑NO PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF PLANNINGAPPL# ❑NOAPPROVALLMER TSTHEBLDCAN ❑YES EICHLERHOSIE? NO RECE BY,.. f TOTALYALUATION: ►�L(�/ By my signature below,) c 'fy tcQach of the following: I am the property owner or authorize ent to act on the property owner's behalf.• I have read this application and the information I have provided is correct. I have read the Description of Work dA verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1 authorize representatives of Cupertino to cater the above--id�c�njtifie rprooperty for inspection purposes. Signature ofApplicant(Agent: Date: 2Jy4' �y7 �, SUPPLEMENTAL INI:ORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXP - SS STANDARD ❑ LARGE -1 MAJOR DINGPLAN REVIEW RANNING PLAN REVIEW PUBLIC WORKS FIRE DEPT NITARY SEWER DISTRICT ❑ ENVIRONPotENTAL EIEALTti B1dgApp_201 Ldoc revised 06121111 �u (• corn It CONSTRUCTION PERMIT APPLICATION ILE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 90300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(dcupertino.Or 1 / ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ I E SlgfN-T�IF'E'� ED�• ORIGINAL PERMIT 1{ PROJECT ADDRESS I o 3} APN b ,.]_,� F -NAME to l (J tl L�.h� t PHOT IE � g t7I �� I V E-MAIL. IC U n —!& A' S �2i7RESS .,lQ��l ! �Ir VL-1%i,I,tQ �-V'rj CITY, STATE, ZIP �t}_() j'l(`JC�d��1P �i FAX 140 -0 VCIlbit— 76 --(,1 ' -< NtAIt tal STREET ADDRESS CITY, STATE, ZIP FAX 13 OWNER ❑ OWNER-Bui DER Il OWNER AGEt,r 0 CONTRACTOR El CON- RACiOR AGENT 0 ARCHiI D ENGwErR Q DEVELOP€R Q TENANT/' CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC 11 COMPANY NAME E -MNL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHTECT/ENGTNEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK s COCA - EXISTING USE PROPOSED USE CONSTR. TYPE I STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER RENIODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKITORCH AREA GARAGE AREA: EIDETACH FI ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? E]NO ADDITION? FINO PRE -APPLICATION [] YES IF YES, PROVIDE COPY OF PLANFNING APPL 5 []NO PLANNING APPROVAL LETTER IS THE BLD G AN ❑ YES EICHLER HOME? I3 NO "RECEIVED HYs` By my signature below, l certify to each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to t 2YCl�d alikve=� e dflcd'pm erty •f r inspection purposes. S;gfZ'W nVINgc71t" Date: �► �OE.{3( SUPPLEMENTAL INFORMATION REQUIREiI rT AN ei¢cK ME,, . _:, aourlHc SLIP_ ; ❑; OVI rt -THF COUNTER , ❑, t3UILDING PLAN REVIEW, _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ' -EXPRESS 0 PI G PI AN.REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure � Cls srnNDnxli"` f ❑ P1 f1d oRKs; _ form if any Hazardous Materials are being used as part of this project.t t ❑ •' "' '0 ' GE - 1 LAR FIREbEPT: _ Copy of Planning Approval Letter or Meeting -with Planning prior to p i<IAiog - ❑ SANPPAItY SEIVEIi DIBTAICI submittal of Building Permit application. n' - - -,w 1' l]- ENVfiZOK SENTAL1IEA1T1I BldgApp_1011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION v ADDRESS: 10391 pineviile ave DATE: 09130/2013 REVIEWED BY: MENDEZ rbfl"/. Perron Fee: APN: BP#: "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: p Plumb, Insp, Fee: PENTAMATION PERMIT TYPE: 1GENRE A WORK truss caics SCOPE Supp!. Insp. Feer Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i c Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the Prefiminary information available and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef 7/1/131 ,bfech. !Tarr Check Plumb. Plun Check FT Elec. Plan Check rbfl"/. Perron Fee: Plnmh. Pernril Fee: F.lec. Perrrril Fee: Other ,lfech, Imp. Other Plumb Insp.Lj Other Elm lisp. Alech. hgpl Fee: Plumb, Insp, Fee: filet°, Insp. Tree: NOTE: This estimate does not include fees due to other Departments (i c Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the Prefiminary information available and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef 7/1/131 FEE QTY/FEE MISC ITEMS Pian Check Fee: Hourly Only? () Yes Q No $0.00 hours Plan Check, Hourly $278.00 ISTPLNCK Suppl. PC Fee: Q Reg, Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp!. Insp. Feer Reg. Q OT 0.4 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONST.4XR 1 0,wits # new $0.00 Administrative Tee: Q G Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure � Travel Doctt,nenlutiorr Fees. Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.001 TOTAL FEE: 1 $278.00 Revised: OB10112013 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10391 PINEVILLE AVE DATE: 02/22/2013 REVIEWED BY: MENDEZ PC FEE ID APN: BP#: 150 01A S ` 'VALUATION: jW0,000 ^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? ° Yes No OTC? Yes Q)No PENTAMATION PERMIT TYPE: 1R3SFDADD WORK ADD 2ND STORY ADDITION 1,139 SQ FT REMODEL 1,500 SQ FT THROUGHOUT E REMOVE SCOPE AND REPLACE 200 AMP PANEL & WATER HEATER AND RE -ROOF GARAGE 4 SQ OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.L PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) I1-B,111-B,1V,V-B 1,139 ;_.6� 1R3PLNCK $1,686.46 1R31NSP Elec, Insp. Fee: $0.00 1 # $27.00 Plumbing 1PRWHEATR Water Heater Permit Fee: $1,686.46 Suppl. Insp. Fee Q Reg. ' Q OT4.0 hrs $0.00 200 amps Electrical $45.00 IBELEC200 Services PME Unit Fee: $0.00 PME Permit Fee: $90,00 443 s.f. Re -roof $75.00 1REROOFRES Construction T m: ' _F7 TOTALS: 1,139 1 $2,506.36 1 $1,686.46 MECH, HOURLY O Yes O No PLUMB, HOURLY C) Yes (F) No ELEC, HOURLY 0 Yes G No Meeh. Plan Check Plumb. Plan Chcck 0.0 1 hrs $0.00 Elec. Plan Check I =.OhTs $0.00 Mech. Permit Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee: ItrPERMIT LAOlf"C111"..rlfecrh. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elea Insp.hrs $45.00 Insp, Fee; Plumb, hrsp. Fee: Elec, Insp. Fee: NOTE: This estimate does not include fees due to other Departments C a Planning, Public Works, Fire, Sanitary Sewer District, School District, *etc.. thesefees are based on the prefindnary information available and are only an estimate Contact the De t or addn'd info, FEE ITEMS (Fee Resolution 11-053 Efi 7/1/12) FEE QTY/FEE MISC ITEMS PIan Check Fee: $2,506.36 E80 s.f. $467.00 Remodel, Other IREMRESOTH Supp]. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 1 # $27.00 Plumbing 1PRWHEATR Water Heater Permit Fee: $1,686.46 Suppl. Insp. Fee Q Reg. ' Q OT4.0 hrs $0.00 200 amps Electrical $45.00 IBELEC200 Services PME Unit Fee: $0.00 PME Permit Fee: $90,00 443 s.f. Re -roof $75.00 1REROOFRES Construction T m: ' _F7 Administrative Fee: 0 E) Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: 1PLLONGR $148.07 Select a Non -Residential Building or Structure G 0 Travel Documentation Fee. 1TRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $45.00 Select an Administrative Item 1 Bldg Stds Commission Fee: 1BCBSC $18.001 SUBTOTALS: $4,538.89 $614.00 TOTAL FEE:_$5r1g 528 Revised: 01/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: j D 3 Cf I T j v) p VAVl- . PERMIT #3 O Z. O l 2S OWNER'S NAME:U nfi j PHONE # YU B 6 / S ' 010/ GENERAL CONTRACTOR: lin P -Y BUSINESS LICENSE # ADDRESS: 1039 1 Pine -v i Oe- Ave , cLyettinv CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: �— Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping i Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner J ontractor Signature O3JIal�01q Date INSTALLATION CERTIFICATE CF-6R-MECH-04 I Space Conditioning Systems, Ducts and Fans (Page 1 of 2 Site Address: 10 3 a I -Pf Q P— V d le- � Enforcement Agency: Permit Number: Cu-ho.V-k-[%n rA_gSultl (3C)2OI2� Space Conditioning Systems Heating Equipment Equip Type (package- heat um CEC Certified Mfr. Name and Model Number ARI Reference Number 2 #of Identical Systems Efficiency (AFUE, etc.) 1,3 (zCF-1R value 4 Duct Location (attic, crawl- space, etc. Duct R -value Heating Load (Btu/hr) Heating Capacity (Btu/hr T Carr;ea� Ao s SO3�14o2 i 95 ✓0 e Pam R-1842-&70 00 -7%O©a Fur hQC� att 59SC5AQ60S1-7WLj s 09 4ol I . 95% AWe- R`8 k5700 700 5 woo Cooling Equipment Equip Type (package heat um CEC Certified Mfr. Name and Model Number ARI Reference Number 2 # of Identical Systems Efficiency (SEER and EER) 1,3 (ZCF-1R value)4 Duct Location (attic, crawl- space, etc. Duct R -value Cooling Load (Btu/hr) Cooling Capacity (Btu/hr condi ho PAi NAO -& 0451(024 I l3 c grac,�l 00 LVG000 CofAhaiv P 12N - r-- 643D63� I I11 sz A4TC- S000 3("000 1. If project is ne►v construction, see Footnotes to Standards Table 151-B and Table 1 SI -C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http:1Avivw. aridirectory. org/ari/ac. php# 3. Listed efficiency on this page must be greater than or equal (>_) to the value shown on the CF -IR form. 4. When CF -IR is reference it also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM 110-§113: HVAC equipment is certified by the California Energy Commission. m § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0"§150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0§ 1500)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine Iines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2 Site Address: ( 03 C1 .I -> l O,eV 111.e Am _ Enforcement Agency: Permit Number: CJ,4PAJ-1QQ CA i t�Q z®l25 Ducts and Fans § 15 (m): Duct and Fans W I. All air --distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the co ination of mastic and either mesh or tape shall be used; and ' 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to caus reductions in the cross-sectional area of the ducts. Y.2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 7. Exhaust fan systems have back draft or automatic dampers. 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 9. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is wat retardant and provides shielding from solar radiation that can cause degradation of the material. 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure,that a completed, signed copy of this Installation Certificate shall be:posted; or made.available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) w, ak- Responsible Person's Name: ° Responsible Person's Si ature: Ko CSLB License: Date Signe •, Position With Company (Title): 0012 P- 2008 Residential Compliance Forms August 2009 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 90300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildino(alcunertina.ora pear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property .gjmprovements specified at: M SITE ADDRESS i i)3g �i'1()pU } i 1 Ave-, APfy BPS 3� 13 - o1s l 3 oz -o1 z� OWNER N1,EL ff1QKliabjSh h � OWNERADDRESS ' Ole -5;L& ��� DESCRIPTION OF WORK: A -d an 0 I GD We are providing you With an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) k Y Ir 1. l understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Ider" building permit that erroneously implies that the properly owner is providing his or her own labor and material sonally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by unlicensed person and his or her employees while working on my property. My homeowner's insurance may not vide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my trance coverage for injuries to workers on my property. kit. I understand building permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility. i3. I understand as an "Owner -Builder" 1 am the responsible party of record on the permit. I understand that I may ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her ie instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license Ders on permits and contracts. -5. 1 understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I may be idered an "employer" under state and federal law. 3. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and 31 government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ployment compensation for each "employee." I also understand my failure to abide by these laws may subject serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by sed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work rformed under contract with a licensed general building Contractor. 3. 1 understand as an Owner -Builder if l sell the property for which this permit is issued, I may be held liable for nancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction is in the workmanship or materials. OwnerBu lderForm 2010.doc revised 04114110 t` ,t I understand I may obtain more information regarding my obligations as an "employer' from the Internal R,e enue Service, the United States Small Business Administration, the California Department of Benefit Payments, an the California Division of Industrial Accidents. I also understand I may contact the Califomia Contractors' State Mc nse Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed O TI 10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that 1 a the party legally and financially responsible for proposed construction activity at the site address listed above. K� 11. l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide k .1b all applicable laws and requirements that govem Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. it Is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you WWI be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: IF Date: " --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work). Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and i personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's 'signature. Property Owner's Signature: Date: 0%werBui7derFor n 2010.doc revised 04114110 Do,&- Osl 1019-b1 Lt ~To -,"h e_ CG,kj � p e v U n 13 Fo,,r5 'th -e -v-ern o P--,-oi e ccs I o'a, R S P i n ev I t It AvE -- i 4— 4 - 13 ® 2-012- -S , Q-) e C ru )'L (-u m car,( S h a� arzr �tl' S h o P � �yw -Lo -�h z� fern ryn i �n We --- cm V --is C �-Luvj( 4 S � 040 S h a -K)